Urodynamics in Female Stress Incontinence

Indications for Urodynamics

The American Urological Association recommends that urodynamics should not be performed routinely in the initial workup of uncomplicated female stress incontinence, but should be reserved for non-index patients with complicating features 1, 2
Urodynamics may be performed at the clinician's discretion in patients with a history of prior anti-incontinence surgery, prior pelvic organ prolapse surgery, significant urgency or urge urinary incontinence symptoms, mixed urinary incontinence, or unconfirmed stress urinary incontinence 1, 2, 3
The Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction suggests that urodynamics are optional even in non-index patients, emphasizing clinical judgment over routine testing 1, 2

Urodynamics can help differentiate stress from urgency components in patients with mixed urinary incontinence or significant urgency symptoms 1, 2, 3
A negative stress test in a patient with typical stress incontinence symptoms is an indication for urodynamics to confirm or refute the diagnosis before proceeding with treatment 1, 2
Diagnostic uncertainty alone may justify urodynamics when the clinical picture doesn't fit typical stress urinary incontinence patterns 4

Patients with neurogenic lower urinary tract dysfunction or grade III or greater pelvic organ prolapse may require urodynamics to characterize their condition 1, 2, 3
Patients with significant voiding dysfunction symptoms or elevated post-void residual may benefit from urodynamics to assess underlying pathophysiology 1, 2, 3